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Hypercortisolemic Depression Is Associated With Increased Intra-Abdominal Fat

From the Central Institute of Mental Health (B.W.-H., F.H., A.K., M.D., M.C., F.L., I.H.), Mannheim; and Department of Psychiatry, Free University of Berlin (I.H.), University Hospital Benjamin Franklin, Berlin, Germany.

Address reprint requests to: Isabella Heuser, Department of Psychiatry, Free University of Berlin, University Hospital Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany. Email: isabella.heuser@ medizin.fu-berlin.de

OBJECTIVE: Similar to patients with a metabolic syndrome, patients with major depression are at increased risk of developing cardiovascular disorders. Interestingly, both disorders share a specific endocrine syndrome that promotes the accumulation of visceral fat, which again is considered a marker of increased cardiovascular morbidity and mortality.

METHODS: Intra-abdominal fat was measured in 22 postmenopausal depressed women and 23 age-matched healthy women by computer tomography at the level of lumbar vertebrae 1 (L1) and 4 (L4). Saliva was taken in patients and control subjects at 08:00 hours over a period of 7 drug-free days for the measurement of free cortisol. In patients only we performed an oral glucose tolerance test.

RESULTS: Compared with control subjects, depressed patients with elevated free cortisol concentrations showed similar visceral fat depots at L1 (113.0 ± 41.6 vs. 94.3 ± 53.2 cm²). Hypercortisolemic depressed patients also showed greater fat depots in this area (74.5 ± 55.5 cm², p = .04) than the normocortisolemic patients. However, a comparison of all patients with control subjects revealed no difference in fat accumulation at either L1 or L4. Finally, glucose concentrations during the glucose tolerance test were higher in hypercortisolemic than in normocortisolemic patients, whereas their insulin levels showed only a tendency toward being increased.

CONCLUSIONS: Hypercortisolemic depressed patients suffer from resistance to insulin and increased visceral fat. The fact that hypercortisolemia reverses depression-related fat loss, particularly in the visceral area, might partially explain why major depression can be considered a risk factor for cardiovascular disorders.

Key Words: major depression, • hypercortisolemia, • visceral fat, • insulin resistance.

Abbreviations: BMI = body mass index;; HAM-D = Hamilton Depression Scale;; HPA = hypothalamic-pituitary-adrenal;; L1 = lumbar vertebra 1;; L4 = lumbar vertebra 4;; OGTT = oral glucose tolerance test.

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